The animating body: psychoid substance as a mutual experience of psychosomatic disorder

Starting from Jung's hypothesis of 'the psychoid', the author suggests that the concept can be extended and understood as a dynamic, relational and interpersonal experience-especially in regressed analytic relations. The author then defines his use of the term 'animating body' as having to do with primitive animal imagery and with psychosomatic symptoms stemming from disturbed pre-verbal and pre-whole-object stages of development. A case of a borderline patient is presented, whose projective identifications into the analyst infected him with her psychosomatic disorder, with her internalized Oedipal confusion and necessarily induced a mutually similar animal dream symbolism. If these embodied countertransference experiences (of desperate merging and sickening identification) can be lived through (tolerated and survived), thought through and interpreted, then they can actually become enlivening and lead to a therapeutic psychosomatic co-ordination.     

Towards an interpersonal understanding of bodily experience

This paper attempts to understand the interpersonal nature of bodily experience. It explores the way the body symptoms we meet in the consulting room, and in everyday life, express and communicate disturbances in our relationships with others. The article seeks to understand how others that are close to us can really get under our skins. The work of the philosopher of the body, MerleauPonty, findings from contemporary developmental psychology, recent psycho-biological studies and psychoanalytic insights are all drawn upon as a way of offering an introduction to contemporary developments in thinking and research on the body.

The article explores the interdependence of body and environment. In particular, the body is always in an interpersonal context with others. Bodies are interdependent; communication is first and foremost bodily. Bodily behaviour and biological functions develop in the context of a relationship. The relationship with the other influences the formation of bodily processes and actions. Clinical examples are drawn upon to illustrate how interpersonal disturbances in development are expressed in bodily symptoms. The difference between a hysterical and psychosomatic body symptom is also briefly addressed.     

Eating disorders as psychosomatic illness the implications for treatment

Abstract

This paper describes a body of theory which points to the possibility that eating disorders can be seen as psychosomatic illness, which is to say a symbolization of affect via the body rather than with words. The author concludes from this that eating disorders may respond better to non-verbal experiential therapies than they do to verbal therapy. She then describes four years of work with groups of eating-disordered women using non-verbal experiential therapies and suggests that the improvement in their symptoms may be the result of these methodologies and that her hypothesis merits further testing and exploration.     

人格维度、自我和谐及行为抑制与心身症状的关系

研究旨在通过实证研究建立人格维度、自我和谐、行为抑制和心身症状之间关系的结构方程模型。对600余名被试问卷测量的相关、回归和结构方程模型分析表明,人格维度可以直接和/或通过行为抑制和自我和谐对心身症状有着正向或负向的预测作用,而且自我与经验的不和谐、行为抑制和心身症状本身都可以作为心理健康的指标,它们之间又存在密切的相互关系     

When the Woman Presents Herself as "the Patient"

The thesis of this paper is that women are delegated by their families, by sociocultural norms and stereotypes, and by the psychotherapeutic community to perform in the role of patient. In many cases women are diagnosed, labeled and treated for supposed intrapsychic difficulties without adequate consideration of the relationships of the woman's social system to the dysfunction. This acceptance of the notion of intrapsychic causation in the woman, while ignoring the larger family system, grows out of a cultural world view which stresses individual self-determination is economically rewarding for the therapeutic community (two-thirds of the client population is female), it does a disservice to the woman and her family. A societal myth is perpetuated of the women as the "problem-bearer" and the one who is "sicker" or "crazier" than others in her family. The woman's symptoms need to be viewed as having interpersonal reality; symptoms are tactics of communication not mythological internalized driving forces with special attraction to the female psyche. An attempt will be made to outline how therapists may unwittingly collude in perpetuating the myth of individual dysfunction in the woman. Ideas are presented for viewing the woman's request for service as an attempt to solve a systemic problem and how therapists, by recognizing the function of the symptom in the woman's social system, can help the woman better define and solve the problem.     

Interpretation of bodily symptoms in hypochondriasis.

Although it has been suggested that hypochondriasis is caused by the misinterpretation of innocuous bodily sensations, support for this hypothesis rests largely upon uncontrolled self-report. We investigated the interpretation of ambiguous bodily sensations in three experiments using separate samples of non-clinical subjects differing in level of hypochondriacal concern. Results confirmed that subjects with high hypochondriacal concern endorse more thoughts about illness interpretations of bodily sensations, but reported thought content resembled 'catastrophic' rather than the 'non-emergency' thoughts suggested by Warwick and Salkovskis (Hypochondriasis. Behavior Research and Therapy, 28, 105-117, 1990). Presence of an interpretive bias was further supported in a study of recognition bias for disambiguated versions of ambiguously threatening sentences, although this applied as much to social as to illness threats. A final experiment failed to support the hypothesis of an automatic inference bias, but did show that subjects with high hypochondriacal concern were quicker to correctly identify previously exposed illness words. Thus, reported thoughts are consistent with catastrophic interpretations of common bodily sensations, but interpretive bias may not be limited to illness threat. However, high hypochondriacal subjects do show a more specific enhanced perceptual sensitivity to illness cues, which may play a role in maintaining their concern with bodily symptoms.     

Supportive psychotherapy of a psychodynamic orientation as an adjunctive treatment for drug-induced depression: A case study

Abstract

Treatment for drug-induced depression usually consists of cessation or reduction of the causative agent and psychopharmacologic management. In addition, psychotherapy can be useful as an adjunctive treatment. The author presents case material related to a young woman with an inborn physical illness, who became depressed during the course of interferon treatment for a medical complication, hepatitis virus infection. In addition to the cessation of interferon and pharmacologic management, supportive psychotherapy of a psychodynamic orientation was started in order to address the patient’s low self-esteem and anxiety about her future. During the course of psychotherapy, it was understood that the premature cessation of interferon was, to her, a narcissistic injury. It was also important to explore the meanings of her inborn illness and her guilty feelings. After reviewing various formulations of depression, the author discusses the case material from an integrative perspective, which describes vicious cycles of depression.     

Depersonalization, vertigo and Ménière's disease

Ménière's disease is generally accepted to be a consequence of distention of the endolymphatic sac of the inner ear. Although the exact etiology is unclear, there is a body of research suggesting that Ménière's disease is of psychosomatic origin. While we do not intend to review the literature exhaustively, we briefly review several frequently cited studies. Even though this literature is so severely flawed that no solid conclusions may be drawn from it, certain questions about the psychological aspect of this disorder continue to surface. Our limited access to patients with vertigo has not allowed us to undertake a carefully designed study. However, in clinical practice we have noted that many persons who complain of vertigo (whether due to Ménière's disease or other causes) also report symptoms of depersonalization and derealization. In this paper we present the cases of two women with Ménière's disease who also experienced concurrent feelings of unreality. It appears likely that feelings of unreality may occur regularly in association with syndromes causing vertigo, presumably as a consequence of vestibular dysfunction. We argue that emotional disturbances previously identified as predisposing causes of Ménière's disease are more likely effects of the disease. Although the discussion of two uncontrolled cases can do little to help solve nagging questions about a psychosomatic component to this disorder, we believe it may suggest a different perspective from which to investigate these complex phenomena.     

Attachment theory: a framework for understanding symptoms and interpersonal relationships in psychosis

We investigated associations between adult attachment, symptoms and interpersonal functioning, including therapeutic relationships in 96 patients with psychosis. Using a prospective design, we also assessed changes in attachment in both psychiatrically unstable and stable groups. We measured attachment using the Psychosis Attachment Measure (PAM) and interpersonal problems and therapeutic relationships were assessed from both psychiatric staff and patient perspectives. Avoidant attachment was associated with positive symptoms, negative symptoms and paranoia. Attachment ratings were relatively stable over time, although changes in attachment anxiety were positively correlated with changes in symptoms. Predicted associations between high levels of attachment anxiety and avoidance and interpersonal problems were supported, and attachment avoidance was associated with difficulties in therapeutic relationships. Findings suggest that adult attachment style is a meaningful individual difference variable in people with psychosis and may be an important predictor of symptoms, interpersonal problems and difficulties in therapeutic relationships over and above severity of illness.     

Aus vier mach zwei

Background

The diagnostic and statistical manual of mental disorders 5 (DSM-5) includes a revision of the DSM-IV criteria for somatoform disorders. The aim of the current work was to investigate whether (a) patients with DSM-IV diagnoses of somatization disorder, pain disorder and hypochondriasis and (b) whether patients categorized as having the DSM-5 somatic symptom disorder and illness anxiety disorder differ with respect to illness anxiety and cognition regarding somatic symptoms.

Material and methods

The data from 269 inpatients from the psychosomatic clinic Schön Klinik Bad Bramstedt were used. Somatoform disorders were diagnosed using the German version of the structured clinical interview for DSM-IV (SCID).

Results

Patients with a DSM-IV diagnosis of hypochondriasis differed in illness anxiety and catastrophizing interpretation of somatic symptoms compared to patients with other somatoform disorders. Patients with illness anxiety disorder differed in the catastrophizing interpretation of physical symptoms, autonomic sensations, bodily weakness and intolerance of physical complaints compared to patients with somatic symptom disorder.

Conclusion

The present results indicate that illness anxiety and a catastrophizing interpretation of somatic symptoms play a fundamental role in patients with somatoform disorders. Therefore, psychotherapy should address illness anxiety and health-related concerns in all patients with somatoform disorders.     

AUTOMATIC RELATIONSHIP–HARM ASSOCIATIONS AND INTERPERSONAL TRAUMA INVOLVING CLOSE OTHERS

Women exposed to violence early in life are at risk of revictimization. The interpersonal schema hypothesis of revictimization proposes that revictimized women will be more likely to hold negative expectations about intimate relationships, including expectations that relationships involve harm, relative to singly or nonvictimized women. To test the interpersonal schema hypothesis, we used the implicit lexical decision task to examine automatic associations between relationship and harm concepts among college women who reported histories of no, single, or multiple types of interpersonal trauma involving close others (e.g., family member, partner). Women exposed to multiple types of interpersonal trauma involving close others showed stronger relationship–harm associations than singly or nonexposed women. Relationship–harm associations predicted the number of interpersonal trauma types (e.g., sexual, physical trauma) involving close others reported by participants, but were unrelated to posttraumatic stress disorder (PTSD) symptoms. Findings suggest that relational schemata held by women exposed to multiple types of interpersonal trauma involving close others include concepts of harm, which may have implications for how multiply victimized women behave in and think about intimate relationships.     

Psychosomatik in der Dermatologie

Psychosomatic dermatology deals with skin disorders that are substantially influenced by psychosocial causes, sequelae or circumstances or in which these are important in the selection of therapy for the particular patient. In this context, skin diseases have been recognized in a biopsychosocial model for holistic medicine. In a wider sense, psychosomatic dermatology embraces every aspect of intra- and interpersonal problems relating to skin disorders and psychosomatic trigger mechanisms and/or ways of coping with skin disorders. A distinction is made between primarily psychic conflicts, psychosomatic diseases and somatopsychic aspects. Approaches to treatment take account of the doctor (doctor’s–assistant)–patient relationship, compliance factors, the dermatosis patient’s quality of life and the psychosocial health of the dermatologist, and also steps that can be implemented in the context of the practice management and basic psychosomatic treatment including referral for special psychotherapy     

Achieving “Narrative Flow”: Pre-Medical Education as an Essential Chapter of a Physician’s Story

This article explores the disconnection between what pre-professional students expect from college and what their undergraduate education might foster, between the focus on "getting into medical school" and the development of humanistic physicians. It reviews the longstanding challenge inherent in helping pre-meds acquire not only sufficient scientific background but also well-developed interpersonal skills to help them understand patients' experience of illness and their own interactions with other members of the health care team. Clinical experiences from the NEH Institute are interpreted from the perspective of a pre-med advisor who also teaches literature; they are also incorporated into an undergraduate course on literature about illness.     

The Accuracy of the DSM-IV Pain Disorder and the ICD-10 Persistent Somatoform Pain Disorder in Chronic Pain Patients

Objectives. In this investigation we studied the relationships between different psychological relevant subgroups and the presence of different psychosomatic symptoms in a sample of chronic pain patients, testing the accuracy of the DSM- and ICD classification systems.Results. We found no evidence for a “pure” pain syndrome according to the DSM- and ICD systems. On the contrary, we found highly significant evidence of a mixed psychosomatic condition.Conclusion. The results suggest a broad somatoform classification, with subgroups based on personality characteristics taking a stress—coping model into account, including interpersonal attachment behaviour. An alternative model of a diagnostic approach is presented.     

Teresa of Avila: The will and the weaving

For more than forty-five years as a Carmelite nun in the sixteenth century, Teresa of Avila suffered from great physical pain. We see in her life how disciplined prayer can become a healing experience that moves from minimal psychic representation to full symbolic representation. After a brief examination of Teresa's life, two theoretical perspectives on somatic manifestation will be reviewed: the theory of conversion hysteria of the classical Freudian school, and the differentiation Joyce McDougall draws between hysterical and psychosomatic phenomena. For the psychosomatic, as the mystic, the void of wordless space has significance. Following after McDougall on the suffering body, a third perspective will be offered: the concept of conscious body suffering as a means to inner change.     

Coniunctio—in bodily and psychic modes: dissociation, devitalization and integration in a case of chronic fatigue syndrome

Three years of analytical psychotherapy with a professional woman in mid-life, suffering from chronic fatigue syndrome (CFS), is described. Gradual recovery merged into mid-life changes; marriage, along with a new balance of maternal and paternal imagos, enabled her to trust enough to become pregnant— coniunctio in the most primal bodily and psychic modes.
Her life-long, schizoid type pattern, 'the pendulum of closeness and isolation', with its extreme of psycho-physical collapse and devitalization, was replayed in therapy. The analyst's symbolic attitude is emphasized, containing the patient's initial affective explosion and validating the physicality of her condition. Mirroring and steady rhythmic attunement became a new, pre-verbal, source of trust—vitalization; differentiation and separation replaced defensive splitting and dissociation. Then the overwhelmingly powerful bodily/maternal could be counterbalanced by the masculine, and a transitional space emerged for symbolic work.
Both the regressive and the dynamic aspects of CFS are located in the earliest undifferentiated, archetypal, bodily/psychic modes, when the frustration of primary needs evokes the defences of the self. It is argued that our psychodynamic understanding can contribute to the stalemate in seeing chronic fatigue syndrome as either an organic illness or depression, and that a new linking of the somatic and psychic calls for a new professional collaboration.     

Validation of a single-item measure of usual physical activity

The purpose of this study was to assess the reliability and validity of a single-item measure of Usual Physical Activity and to assess its usefulness as a physical activity tool for perimenopausal women. 188 perimenopausal women participated (age: M = 47 yr., SD = 3; range = 40-55). Data were collected using the Women's Health Assessment Scale, the Physical Activity Questionnaire, the Perimenopause-related Quality of Life Scale, a health history and demographic questionnaire, and the rater. Scores were stable over a 2-wk. interval. Convergent validity was supported by a correlation of .66 between ratings on Usual Physical Activity and the Physical Activity Questionnaire. Concurrent validity was supported by the association of the rating of Usual Physical Activity with three parameters of Body Mass Index, psychosomatic symptoms, and perimenopause related quality of life, known to be associated with physical activity. Highly active women had a lower Body Mass Index than less active and inactive women. Active women tended to report fewer and less distressing psychosomatic symptoms and better quality of life. These findings support the use of rating of Usual Physical Activity to classify perimenopausal women into categories of physical activity.     

Regulating damage claims for emotional injuries before the First World War

During the late 19th century, as a result of litigation following railway accidents, damage claims for emotional injuries became a medico-legal issue. Efforts to find fair and socially acceptable means of settling such claims involved an interaction between medical theory and legal rules. Between 1866 and 1890 doctors debated the significance of ‘nervous’ symptoms, which resulted from accidents in which Little or no physical damage occurred. They rejected a strictly somatic interpretation of these symptoms and replaced it with a psychosomatic interpretation. Hoping to prevent a fiood of ‘false claims’, Anglo-American courts initially rejected this psychosomatic interpretation, and ruled against damages in cases where fear without physical impact was the cause of the plaintiffs symptoms. Later, common law courts accepted the psychosomatic perspective and granted damages for physical illnesses in which fear was ‘one link in the chain of causation’. While early appeals under workers' compensation laws followed these later courts, worries about the social consequences ofthese rulings were also evident in the years before the First World War.     

Medicine's symbolic reality

Modern socio‐cultural studies of medicine demonstrate the symbolic character of much of medical reality. This symbolic reality can be appreciated as mediating the traditional division of medicine into biophysical and human sciences. Comparative studies of medical systems offer a general model for medicine as a human science. These studies document that medicine, from an historical and cross‐cultural perspective, is constituted as a cultural system in which symbolic meanings take an active part in disease formation, the classification and cognitive management of illness, and in therapy. Medicine's symbolic reality also forms a bridge between cultural and psychophysiological phenomena; the basis for psychosomatic and socioso‐matic pathology and therapy. This in turn becomes a central problem for medical theory and for a philosophical reinvestigation of medicine.